Thoracoscopic surgery

Abstract

Thoracoscopic procedures or video-assisted thoracoscopic surgeries (VATS) are thoracic surgeries that are minimally invasive and use the aid of a video camera. The first clinical use of the thoracoscope was in 1916 for intrapleural pneumolysis on patients with tuberculosis (TB). It wasn’t until the late 20th century with the development of fibre optic technology that its use for diagnostic and therapeutic procedures became more widespread. Surgeons are now able to look at images projected onto a monitor with the aid of computer chip television cameras. This frees up their hands and allows them to perform a variety of procedures as well as more complex procedures.

The preoperative assessment of patients coming for thoracoscopic surgery must be as robust as that for open thoracotomy procedures. Pulmonary function tests can be used to determine if patients will be suitable for one lung ventilation. There must be ongoing discussions with the surgeons to determine the surgery planned and how feasible it is.

VATS sometimes requires lung isolation techniques. The double-lumen tube (DLT) has long been considered the gold standard in one lung ventilation procedures. The choice of anaesthetic technique when it comes to one lung ventilation will depend on the anaesthetist’s experience and skill. The fibre optic scope has now become the gold standard for confirming tube position. To avoid ventilator-induced lung injury, a strategy of lung protective ventilation should be employed.

Patients going for thoracoscopic procedures at a minimum are placed in a high dependency care setting. Adequate analgesia is vital to recovery. Analgesic approach must be multimodal. Regional techniques such as thoracic epidural, paravertebral blocks, intercostal nerve blocks and epidural catheters are widely favoured. Nausea and vomiting prophylaxis should be prescribed.

Anaesthesia for thoracoscopic surgery is an interesting and challenging field. It requires good knowledge of the physiology and thorough preparation.